Amanda Wilde (Host): The first 1000 days of a child's life, from the moment they're conceived until they reach two years of age, is a time when their brain, body, and immune system grows and develops. We'll talk about the lifelong implications of those first thousand days with Dr. Molly Parker, Population Health Chief Medical Officer at Jefferson Healthcare.

 This is To Your Health, a podcast from Jefferson Healthcare. I'm Amanda Wilde. Molly, good to speak with you.

Molly Parker, MD, MPH: Oh, thanks for having me.

Host: Why are the first 1000 days of life important for a child?

Molly Parker, MD, MPH: The first 1000 days really start when the two cells come together to start a new life and continue on a thousand days until about the age of two. And you can imagine that in that time period, a bean is going from two cells to billions of cells. So what happens during that timeframe is incredibly important and starts the path for the rest of their life forward.

Host: What are the stages covered in those first 1000 days?

Molly Parker, MD, MPH: They specifically cover the prenatal period, so from conception until delivery, and then that newborn period all the way until age two. We think about those thousand days as the development of a human being. But there is a stage before that, that's also important that goes into the preconception time that influences being's life as well. So the time before, say time zero, is also really important. And I'll talk a little bit about that as well.

Host: Why is preconception important?

Molly Parker, MD, MPH: Well, it's really fascinating. So, a woman's body is preparing for a pregnancy that's about to come. It may be planned or unplanned, and that preparation sets up the environment for the fetus. So if the woman has good nutrition, is low stress, lives in an environment without a lot of toxins, her body is really ready to go. And that sets her up for being ready to gestate a healthy human being.

Host: Yeah, you're reminding me how proper nutrition really plays a role even before a child is conceived. What about in those first thousand days we're talking about from conception on, how does nutrition and healthcare fit in there?

Molly Parker, MD, MPH: Yeah. It's incredibly important. So, when a pregnancy begins, we start out with those two cells. By four weeks, there are about 10,000 early brain cells. By six months, there are 10 billion brain cells. So in that time period, the nutrition supports the development of that new infant's brain. Stress also plays a big role on the pathways that affect the neurologic development of that infant. So if a pregnant person is under a lot of stress, that can make a huge difference in how that infant develops, and we'll see that later on, as studies have shown that infants who were gestated under times of stress will have changes in cognition that we can see later on in kindergarten and on into university and on into the rest of their life.

So that environmental mileau is really important during pregnancy.

Host: So stress and nutrition play a role. Genetics?

Molly Parker, MD, MPH: Yeah, genetics play a big role, but also the genetics are changing during that time. So, any environmental stressors, for example, smoking or alcohol or pollution, can also make a difference in how that fetus develops. So any exposures may affect the genetics of that infant as it develops.

Host: So we're saying that during this first thousand days, everything is growing so significantly, the brain, the body, the immune system. What do you do in your role as Population Health Chief Medical Officer at Jefferson Healthcare?

Molly Parker, MD, MPH: Yeah, I'm really lucky in my role. I work part-time as a family doctor and take care of people of all ages, including delivering babies, and prenatal care and postpartum care. But in my Population Health role, I am able to step back and look at a whole population. For example, our county or women of reproductive age and say, what can we do to make their health the best it can be? What interventions can we create to improve the health of our community? So what I'm able to do is look at interventions that make a big difference. So for example, making sure prenatal care happens, making sure families have the tools they need to care for a newborn and a toddler. Making sure there are supports for them in the community.

And so we've come up with a number of interventions that help along these whole thousand days to support a family as they raise their child.

Host: Yes. That was my next question, which you've led right into is what Jefferson Healthcare is specifically doing to support the first thousand days of life.

Molly Parker, MD, MPH: Yeah, we have a whole list of things that we do. It actually starts before the first thousand days of life. One of our most recent projects was working with a group called Upstream to improve our systems around contraceptive offerings, to be sure that we are asking families if they're ready to have a baby, if they want have a baby and making sure that people are becoming pregnant when they want to become pregnant. So that whole project, is just launching now. It's really exciting. That has been one of our primary projects, but then entering into the prenatal care period, we of course provide prenatal care. We do deliveries here, and then we provide the postpartum care and the well child checks, all the traditional medical pieces, but from Population Health, we've also added in programs, including our Cribs for Kids program, where we teach pregnant families about safe sleep and give them a cribette which is like a Pack and Play which is a safe place for their baby to sleep and protects babies from SIDS or sudden infant death syndrome.

We've developed some food programs, so we for families who may not have food at home when they come home from the hospital after having a baby, we have a three day supply of food that our chef creates for them and sends home. It's really lovely. We have another program after that starts during well child checks where we're able to offer coupons for our farmer's market in the county. We have two farmers markets and families who qualify can get a punch card where they can get a certain amount of vegetables every month throughout our whole farmer's market period. And this allows our young families to teach their kids about healthy food and local food. It also provides us as physicians an opportunity to talk to our families about nutrition and the importance of that on the growing brain.

Another program we have is called Reach Out and Read. We've partnered with the national organization Reach Out and Read where we are able to give books to all of our kids who have well child checks, starting at six months. It's been shown that if parents read to their children for 20 minutes a day, even starting as early as infancy, they'll be more ready for kindergarten. put learn to talk sooner. They'll learn to read sooner. And the outcomes are really incredible, from that program. So in Population Health, we curate the evidence and the programs that are out there that might make a difference for our population. And then we put them into action here.

Host: And you really see them have an effect?

Molly Parker, MD, MPH: It makes a huge difference. It doesn't take a lot of money to be able to read to your kid every day. And the families who do that, are see their children, enter kindergarten so much more prepared. And I just feel honored as a family doctor to be able to see that transition from a pregnancy all the way up through five years old. And then I get to track them a long time after as well.

Host: Well, Dr. Parker, thank you for your important work, supporting families and providing resources, and for explaining how the first 1000 days of a child's life sets the framework for the future.

Molly Parker, MD, MPH: Well, thank you.

Amanda Wilde (Host): That was Dr. Molly Parker, Population Health Chief Medical Officer at Jefferson Healthcare. For more information, go to jeffersonhealthcare.com/population-health. And if you found this podcast helpful, please share it on your social channels.

You can check out the full podcast library at jeffersonhealthcare.org. This is To Your Health, a podcast from Jefferson Healthcare. Thanks for listening, and be well.